Immediate and mediate furcal perforation treatment in primary molars: 24-month follow-up.

BACKGROUND: Furcal perforation consists of a communication between the pulp cavity and the periodontal tissues that can occur accidentally during cavity preparation or root canal instrumentation. This complication may lead to inflammatory reactions and compromise adjacent tissues irreversibly, resulting in the early loss of primary teeth. Perforation sealing with a biocompatible material is necessary to ensure a favourable prognosis. Among different materials, MTA has been employed due to its excellent healing and physical properties. CASE REPORT: The purpose of these case reports was to describe immediate and mediate cases of furcal perforation treatment using MTA in primary molars. In both the cases, after accidental perforation detection, the pulp chamber was cleaned with saline solution to clear off the debris. The wound surface was continuously irrigated with saline solution and a dry sterile cotton pellet was placed on the radicular pulp stumps and perforation area with slight pressure until the bleeding was controlled. The MTA was applied into the perforation and pulp chamber area with the aid of a sterile amalgam carrier. The teeth were restored with resin-modified glass ionomer cement. FOLLOW-UP: Clinical and radiographic follow-up examinations were carried out at 3, 6, 12, 18, and 24 months after perforation sealing. Both the cases remained asymptomatic, presenting no discomfort, mobility, swelling, or fistula after 24-months follow-up. Radiographically, the radiolucent area disappeared as a result of bone formation in the inter-radicular space, showing adjacent tissue preservation. CONCLUSION: Thus, MTA may be considered as an ideal option for conservative treatment of immediate and mediate furcal perforation in primary teeth, once it promoted repair with tooth maintenance in both the cases.

Pulp tissue response to Portland cement associated with different radio pacifying agents on pulpotomy of human primary molars.

The objective of this research was to evaluate the response of Portland cement associated with different radio pacifying agents on pulp treatment of human primary teeth by clinical and radiographic exams and microscopic analysis. Thirty mandibular primary molars were randomly divided into the following groups: Group I - Portland cement; Group II - Portland cement with iodoform (Portland cement + CHI3 ); Group III - Portland cement with zirconium oxide (Portland cement + ZrO2 ); and treated by pulpotomy technique (removal of a portion of the pulp aiming to maintain the vitally of the remaining radicular pulp tissue using a therapeutic dressing). Clinical and radiographic evaluations were recorded at 6, 12 and 24 months follow-up. The teeth at the regular exfoliation period were extracted and processed for histological analysis. Data were tested using statistical analysis with a significance level of 5%. The microscopic findings were descriptively analysed. All treated teeth were clinically and radiographically successful at follow-up appointments. The microscopic analysis revealed positive response to pulp repair with hard tissue barrier formation and pulp calcification in the remaining roots of all available teeth. The findings of this study suggest that primary teeth pulp tissue exhibited satisfactory biological response to Portland cement associated with radio pacifying agents. However, further studies with long-term follow-up are needed to determine the safe clinical indication of this alternative material for pulp therapy of primary teeth.

Clinical and radiographic evaluation of Portland cement added to radiopacifying agents in primary molar pulpotomies.

AIM: This was to evaluate the clinical and radiographic outcomes of Portland cement (PC) added to radiopacifying agents in primary molar pulpotomies. METHODS: Thirty primary mandibular molars of children aged between 5 and 9 years were randomly assigned to the following groups: PC; PC with iodoform (PC + CHI(3)); PC with zirconium oxide (PC + ZrO(2)) and treated by pulpotomy technique. Clinical and radiographic follow-up assessments were performed at 6, 12 and 24 months. Statistical analysis was performed by Fisher's exact test (P < 0.05). RESULTS: The clinical and radiographic evaluations showed 100 % success rates, and the results showed no statistically significant difference between groups. CONCLUSIONS: According to this study, PC added to radiopacifying agents exhibited satisfactory clinical and radiographic results in primary molar pulpotomies.

Clinical, radiographic and histologic analysis of the effects of pulp capping materials used in pulpotomies of human primary teeth.

AIM: To compare the clinical, radiographic and histological responses of the pulp to mineral trioxide aggregate (MTA), calcium hydroxide (CH) and Portland cement (PC) when used as a pulpotomy agent in human primary teeth. STUDY DESIGN: Forty-five mandibular primary molar teeth were randomly assigned to CH, MTA or PC groups and treated by pulpotomy technique. METHODS: The teeth were treated by conventional pulpotomy technique, differing only in the capping material for each group. Clinical and radiographic evaluations were recorded at 6-, 12- and 24-month follow-up. Teeth in the regular exfoliation period were further processed for histologic analysis. STATISTICS: Data were tested using parametric tests at a significance level of 5 %. The histological results were expressed descriptively. RESULTS: Clinically and radiographically, the MTA and PC groups showed 100 % success rates at 6, 12 and 24 months. In CH group, several teeth presented clinical and radiographic failures detected throughout the follow-up period, and internal resorption was a frequent radiographic finding. Histologic analysis revealed the presence of dentine-like mineralised material deposition obliterating the root canal in the PC and MTA groups. CH group presented, in most of the sections, necrotic areas in the root canals. CONCLUSIONS: MTA and PC may serve as effective materials for pulpotomies of primary teeth as compared to CH. Although our results are very encouraging, further studies and longer follow-up assessments are needed in order to determine the safe clinical indication of Portland cement.